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Kelly-Schuette KA, Prentice A, Orr A, Levine A, Zarnke A, Pardington E, Pounders S, Lypka M, Krech L, Iskander G, Chapman AJ, Gibson CJ, Steensma E, Durling L. Rib Fracture Mortality: Are there clues in the core? J Surg Res 2021; 268:25-32. [PMID: 34280662 DOI: 10.1016/j.jss.2021.06.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 05/11/2021] [Accepted: 06/10/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Sarcopenia is associated with increased morbidity and mortality in the trauma patient. The primary objective of this study was to determine the relationship of psoas cross sectional area with hospital mortality in patients with rib fractures over the age of 55 years. MATERIALS AND METHODS We retrospectively reviewed 1223 patients presenting to a Level 1 Trauma Center between 1/1/2002 and 1/31/2019. Psoas cross sectional area was measured using a polygonal tracing tool. Patients were stratified into four quartiles based on sex-specific values. RESULTS There was increased in-hospital mortality for patients with a lower psoas cross sectional area (10 %, 8%, 6%, and 4%, Q1-Q4 respectively; P=0.021). The logistic regression model determined for every increase in psoas cross sectional area by 1 cm2 the odds of in-hospital mortality decreased by 4%. CONCLUSIONS In-hospital mortality is multifactorial; however, psoas cross sectional area may provide a clue in predicting adverse outcomes after traumatic rib fractures.
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Affiliation(s)
- Kathrine A Kelly-Schuette
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI.
| | - Anthony Prentice
- Spectrum Health Department of Nursing, Surgical Services, Grand Rapids, MI
| | - Adam Orr
- Spectrum Health/Michigan State University College of Human Medicine Diagnostic Radiology Residency, Grand Rapids, MI
| | - Anna Levine
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI
| | - Allison Zarnke
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI
| | - Emily Pardington
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI
| | - Steffen Pounders
- Spectrum Health Office of Research, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Matthew Lypka
- Spectrum Health Office of Research, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Laura Krech
- Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Gaby Iskander
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Office of Research, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Alistair J Chapman
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Charles J Gibson
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Elizabeth Steensma
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
| | - Luke Durling
- Spectrum Health/Michigan State University College of Human Medicine General Surgery Residency, Grand Rapids, MI; Spectrum Health Acute Care Surgery, Grand Rapids, MI; Spectrum Health Trauma Research Institute, Grand Rapids, MI
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Geary SP, Brown MR, Decker C, Angotti LM, Ata A, Rosati C. Patient Characteristics Associated with Comfort Care among Trauma Patients at a Level I Trauma Center. Am Surg 2018. [DOI: 10.1177/000313481808401144] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Trauma patients admitted to the intensive care unit are a unique population with high mortality. This study aims to identify characteristics predicting the likelihood of progressing to palliative management often referred to as comfort care measures, thus enabling the trauma team to broach end-of-life decisions earlier in these patients’ care. This is a retrospective analysis of the prospectively collected New York State Trauma Registry database for a single Level I trauma center for patients admitted from 2008 to 2015. During this time, a total of 13,662 patients were admitted to the trauma service and there were 827 deaths, resulting in a crude annual mortality rate of approximately 6 per cent. Approximately one-half of the total mortalities, 404 of 827 (48.9%), were ultimately designated as comfort care. Univariate analysis identified the following risk factors for comfort care designation: advanced age, multiple comorbidities, blunt trauma mechanism, traumatic brain injury, and admission location. Multivariate analysis confirmed advanced age and traumatic brain injury. Subgroup analysis also identified advanced directives, pre-existing dementia, and bleeding disorders as significant associations with comfort care designation. The identification of factors predicting comfort care will result in improved care planning and resource utilization.
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Affiliation(s)
- Sean P. Geary
- Department of Emergency Medicine, Albany Medical Center, Albany, New York
| | - Maria R. Brown
- Department of Surgery, Albany Medical Center, Albany, New York
| | | | - Lisa M. Angotti
- Department of Surgery, Albany Medical Center, Albany, New York
| | - Ashar Ata
- Department of Surgery, Albany Medical Center, Albany, New York
| | - Carl Rosati
- Department of Surgery, Albany Medical Center, Albany, New York
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Clinical Outcome and Management for Geriatric Traumatic Injury: Analysis of 2688 Cases in the Emergency Department of a Teaching Hospital in Taiwan. J Clin Med 2018; 7:jcm7090255. [PMID: 30181469 PMCID: PMC6162823 DOI: 10.3390/jcm7090255] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 08/23/2018] [Accepted: 09/03/2018] [Indexed: 01/06/2023] Open
Abstract
Geriatric traumatic injuries in emergency departments are frequent and associated with higher mortality rates and catastrophic functional outcomes. Several prediction scores have been established to manage traumatic patients, including the shock index (SI), revised trauma score (RTS), injury severity score (ISS), trauma injury severity score (TRISS), and new injury severity score (NISS). However, it was necessary to investigate the effectiveness and efficiency of care for the geriatric traumatic population. In addition, image studies such as computed tomography and magnetic resonance imaging play an important role in early diagnosis and timely intervention. However, few studies focus on this aspect. The association between the benefit of carrying out more image studies and clinical outcomes remains unclear. In this study, we included a total of 2688 traumatic patients and analyzed the clinical outcomes and predicting factors in terms of geriatric trauma via pre-hospital and in-hospital analysis. Our evaluation revealed that a shock index ≥1 may be not a strong predictor of geriatric trauma due to the poor physical response in the aging population. This should be modified in geriatric patients. Other systems, like RTS, ISS, TRISS, and NISS, were significant in terms of predicting the clinical outcome.
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Heinrich D, Holzmann C, Wagner A, Fischer A, Pfeifer R, Graw M, Schick S. What are the differences in injury patterns of young and elderly traffic accident fatalities considering death on scene and death in hospital? Int J Legal Med 2017; 131:1023-1037. [PMID: 28180986 DOI: 10.1007/s00414-017-1531-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 01/03/2017] [Indexed: 11/28/2022]
Abstract
Older traffic participants have higher risks of injury than the population up to 65 years in case of comparable road traffic accidents and further, higher mortality rates at comparable injury severities. Rib fractures as risk factors are currently discussed. However, death on scene is associated with hardly survivable injuries and might not be a matter of neither rib fractures nor age. As 60% of traffic accident fatalities are estimated to die on scene, they are not captured in hospital-based trauma registries and injury patterns remain unknown. Our database comprises 309 road traffic fatalities, autopsied at the Institute of Legal Medicine Munich in 2004 and 2005. Injuries are coded according to Abbreviated Injury Scale, AIS© 2005 update 2008 [1]. Data used for this analysis are age, sex, site of death, site of accident, traffic participation mode, measures of injury severity, and rib fractures. The injury patterns of elderly, aged 65+ years, are compared to the younger ones divided by their site of death. Elderly with death on scene more often show serious thorax injuries and pelvic fractures than the younger. Some hints point towards older fatalities showing less frequently serious abdominal injuries. In hospital, elderly fatalities show lower Injury Severity Scores (ISSs) compared to the younger. The number of rib fractures is significantly higher for the elderly but is not the reason for death. Results show that young and old fatalities have different injury patterns and reveal first hints towards the need to analyze death on scene more in-depth.
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Affiliation(s)
- Daniela Heinrich
- Ludwig-Maximilians-University (LMU) Munich, Institute of Legal Medicine, Nussbaumstrasse 26, D-80336, Munich, Germany.
| | - Christopher Holzmann
- Department of Accident and Reconstructive Surgery, Hospital of the RWTH University Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany
| | - Anja Wagner
- Ludwig-Maximilians-University (LMU) Munich, Institute of Legal Medicine, Nussbaumstrasse 26, D-80336, Munich, Germany
| | - Anja Fischer
- Ludwig-Maximilians-University (LMU) Munich, Institute of Legal Medicine, Nussbaumstrasse 26, D-80336, Munich, Germany
| | - Roman Pfeifer
- Department of Accident and Reconstructive Surgery, Hospital of the RWTH University Aachen, Pauwelsstrasse 30, D-52074, Aachen, Germany
| | - Matthias Graw
- Ludwig-Maximilians-University (LMU) Munich, Head of the Institute of Legal Medicine, Nussbaumstrasse 26, D-80336, Munich, Germany
| | - Sylvia Schick
- Ludwig-Maximilians-University (LMU) Munich, Institute of Legal Medicine, Nussbaumstrasse 26, D-80336, Munich, Germany
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